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An Egyptian worker cleans a chicken farm near Jamasa city, north of Cairo, as Egypt experiences the third human death in less than a week. The possibility of a pandemic from the virus that causes bird flu could increase in 2008, Art Caplan warns.

This is the time of year when, optimism firmly in hand, we anticipate all the great things that await us.

Not gonna happen, at least when it comes to scientific and medical progress. I arrive bearing bad news about the coming year. Plenty of it.

So, ye be warned! My predictions for 2008:

Biggest disappointment
One of the
most exciting breakthroughs
to occur last year was the simultaneous discovery of how to make a type of skin cell behave as if it were an embryonic stem cell. Teams in Japan and Wisconsin announced that they had induced pluripotency in skin fibroblasts, meaning the cells had the power to turn into virtually any kind of human tissue. Most of those in the United States involved in the national hair pull over the morality of using human embryos as a source of stem cells for medical research heaved a huge sigh of exhausted relief.

Who on either side could stand one more round of overly heated debate? Inducing pluripotency to turn skin cells in embryo-like cells is a compromise we can all support, right?

Well, kind of. While plenty of research will get done on this new source of stem cells in 2008 and beyond, it will quickly become evident that the techniques used to switch on the genes in adult skin cells are
fraught with problems
that make transplanting induced pluripotent cells into the human body a highly dangerous and highly unlikely thing to try. As a result, we'll be back to human embryos and cloned human embryos as the most promising sources of transplantable cells. It will be back to the new president and the new Congress to figure out whether they are going to spend money in this area or watch as the rest of the scientific world passes by the USA.

Easiest to predict disappointment
It is obvious that the American health care system is broke. It
costs too much
and for too many yet too often delivers poor quality of care. As the presidential campaign moves along, many are looking forward to an intelligent debate about how finally to fix it. Uh, not so fast.

The American health care system has been broken for the past three decades and nothing radical has been done to fix it yet. Moreover, the nation is running a huge debt from its overseas wars and profligate loan and credit habits. This is not a formula for fixing anything about health care anytime soon.

But we can look for the still worthwhile effort to ensure that all children under 18 have decent health insurance. That is about it for health reform for quite awhile. Even that is
no sure thing
.

Biggest continuing frustration
In a recent column
I noted with some sadness that the latest trial of an HIV vaccine by Merck had to be stopped prematurely due to a higher rate of deaths in the placebo arm of the study. I did not get this right. Instead there was a
higher rate of HIV infection
among those who got vaccinated than in the placebo group. Analysis of what actually happened is expected in 2008. It is still not likely to be good news.

The HIV vaccine itself may or may not be responsible for higher infection rates in those who got it, but it is very unlikely that it did anyone any good. This vaccine was one of the most anticipated of all those being developed. It will take a long time to figure out what happened in this study and to come up with some
new approaches
for bolstering a person’s immune response to the virus, in addition to generating support for testing again and to then run trials on new vaccines and get them anywhere close to widespread use in humans. Expect to hear more about putting more
emphasis on education
, condoms, circumcision and controlling other infections that increase the risk of getting AIDS. There will also be more stories on the utter horror that HIV continues to cause in Africa and parts of Asia.

Biggest unjustified freak-out
For many years now, teams of scientists have been getting closer and closer to creating a life form that has never existed on earth. 2008 is the year they succeed in creating synthetic life.

Scientists are attempting to manufacture synthetic life in order to create truly programmable microorganisms that could do things like eat oil slicks or the fatty deposits in our arteries, synthesize hydrogen for fuel or even pull carbon dioxide out of the air to stop global warming.

The creation of a synthetic virus — built from a novel set of genes — that does what other viruses can do, in terms of infecting bacteria and propagating, is going to happen. A number of labs are close to pulling this off, including: the Massachusetts Institute of Technology; the State University of New York, Stony Brook; J. Craig Venter Institute, Rockville, Md.; ProtoLife, Venice, Italy, and the Foundation for Applied Molecular Evolution, Gainesville, Fla.

The anticipated announcement that we have unlocked the formula to life itself will trigger some pretty nutty responses from those least in a position to understand what was done.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Ignore the hyperventilating commentary. Synthetic life in viral form is a huge achievement because it is the creation of a living thing for the first time by human hands. But it's not one that necessitates any revision of humanity’s overall standing in the cosmos.

Biggest real reason for freaking outAnyone remember pandemic flu? This is the nasty strain of flu that is carried by birds, but once in awhile jumps to other species, including us. For awhile the U.S. media and government were all aflutter over the possibility of an avian flu pandemic as a small number of human deaths were reported in Asia, and as confirmed cases in birds spread worldwide. But nothing happened. No plague. Everyone lost interest. Time to get interested again.

The virus that causes avian flu is
still around
, killing birds and an occasional person. It continues to mutate. Scientists tracking the virus have seen subtle changes that make it very likely that this year we are going to get a strain that not only goes from birds to birds and birds to people, but also from
people to people
. That is when we get the real chance of a pandemic.

The evolution of the virus says it is getting close to getting ready to do us a lot of harm. Last year a bird flu vaccine was approved for human use. How effective it will be or how much of it will be available is not clear. In 2008 the nations of the world better get ready to deal with this time bomb that has not stopped ticking.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.